Direct impact upon the bicycle handlebars is an especially harmful mechanism of injury in children. Pediatric patients who present following direct impact of the bicycle handlebars upon the abdomen are much more likely to suffer internal organ injury and require operative intervention than those who present following a bicycle accident without direct impact upon the handlebars. Unfortunately, bicycle handlebar trauma is not only a damaging mechanism of injury, but also a treacherous one. Physical exam findings can be subtle; these children often appear misleadingly well. Many such children are initially misdiagnosed and sent home prematurely only to re-present. Delays in definitive diagnosis are typical. The radiologist, therefore, by aiding in the timely identification of injuries and determination of any need for surgery, can make a valuable contribution to patient care. Our cases include a 9-year-old girl with a puncture wound and abscess in the medial thigh musculature, a 13-year-old male with a penetrating wound to the left lower abdominal quadrant with extensive retroperitoneal and extraperitoneal hematoma and other injuries, a 14-year-old male with a hematoma in the right lower abdominal quadrant, and a 7-year-old boy with a liver laceration, each of whom suffered a bicycle handlebar impact to the abdomen. As companion cases, we also present a 12-year-old boy with a transected pancreas following an ATV rollover which involved impact of the handlebars upon the abdomen, and a 49-year-old man who sustained a shattered kidney in a bicycle accident. Read More

Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019

Authors: Mccrary Joseph, Talmadge Jennifer

Keywords: bicycle

Accidental traumatic injuries of the pancreas are rare but dangerous. In children, blunt abdominal trauma is the most common mechanism. The goal of this presentation is to review, through a series of cases, the diagnosis, imaging findings, classification, and management of accidental traumatic pancreatic injuries in children. Our cases include an 18-year-old football player with traumatic pancreatitis and pseudocyst formation, a 12-year-old pinned between two vehicles who sustained a pancreatic laceration with full transection of the pancreatic duct, a 15-year-old soccer player with a pancreatic laceration and truncated duct on ERCP, and a 5-year-old boy who was run over by a car and developed shock pancreas. Traumatic injuries, as graded by the guidelines of the American Association for the Surgery of Trauma, span a gamut including contusion, laceration, transection, duct injury, ampulla injury, and massive destruction of the pancreatic head. Complications include fistula, pancreatitis, and the development of pseudocysts. Through multiple imaging modalities - including CT, MR, MRCP, ERCP, and ultrasound – our cases illustrate many of these injuries and subsequent complications. While nonoperative treatment of minor pancreatic injuries is widely accepted, the management of more severe pancreatic injuries, such as those involving the pancreatic duct, is more controversial. Duct injury, for example, has been reported to be predictive of failure of non-operative management. The radiologist, therefore, has the opportunity to play a pivotal role in patient care by characterizing the injury. Pancreatic organ and duct injuries can be subtle and correlation with multiple modalities as well as multidisciplinary discussion between the radiologist, surgeon, and gastroenterologist, are often required. Read More

Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018

Authors: Mccrary Joseph, Talmadge Jennifer

Keywords: Trauma, Pancreas